Permit CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007.00685
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/21/2007
Phone: (503) 639 -4171 r• �II
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/29/2007 TIME: 7 :00AM PAGE: 38
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: (1) sign lighting
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 503 - 626 - 3800
CONTRACTOR: SECURITY SIGNS INC PHONE #: 503-546-7114
Inspection Request Scheduled For: Date: 11/29/2Q07 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final • 080470-01 503.546 4115 '_ Y
Corrections /Comments/ Instructions:
AN 329 - s 2 I-R
F-fN AL AND �� AepR.o
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1\Av5 rr 0P 6\R0vN• k
C.bNn ci�T 6L.z) A) DN Ke
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
7 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: & Nutx Date: VII 21((9 Phone #: (503) 718 - viLibr
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 Ott X84;
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8!21/2007
Phone: (503) 639 - 4171'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/1/2007 TIME: 7:O2AM PAGE: 34
SITE ADDRESS: 1105() SW 67TH AVE CLASS OF WORK:
SUBDIVISION: 11GARD TRIANGLE COMMONS LOT #: (J07 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: (1) F:ign lighting
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 503 - 62&3800
CONTRACTOR: SECURITY SIGNS INC PHONE #: 50354G7114
Inspection Request Scheduled For: Date: 11/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final OS8800 -01 .0354&7114 N
Corrections /Comments/ Instructions:
Q t� CZO v1® pct o E ( F
bi S cbN
❑ PASS ❑ PARTIAL APPROVAL XCANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V" '► 6,6 l..0 Date: I I ' - Ur) Phone #: (503) 718- 2"1 IO
• CITY OF TIGARD ELECTRICAL PERMIT
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1 PERMIT #: ELC2007 00585
COMMUNITY DEVELOPMENT DATE ISSUED: 8/21/2007
TiGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT : 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: (1) sign lighting
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
. 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
MANF HMI SVCI FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC NORTHWEST PROPERTIES SECURITY SIGNS INC
6600 SW 105TH AVE 2424 SE HOLGATE BLVD
SUITE 175 PORTLAND, OR 97214
BEAVERTON, OR 97008
Phone: 503 - 626 -3880 Contact #: PRI 503 - 546 -7114
FAX 503 - 230 -1861
FEES
Description Date Amount Reg #: ELE 26 560CLS
[ELPRMT] ELC Permit 8/21/2007 $53.40 LIC 122809
[TAX] 8% State Surcharge 8/21/2007 $4.27 SUP 383 SIG
Total $57.67 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to'follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: �z�.d
Perm Si nature: , ��i
Y g �ir /-�
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Elktirkal Permit Applicoithin �ED 1 c)R c i I l(I u�l UN.
(f of'Y'Igard Received �� Date /B : _ 0 3_6 Permit N. . . .. .7 , 0 6
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review , � ll
Phone: 503.639.4171 Fax: 503.598.1960 AUG 4 i 2001 1 16- Date /B : Other Permit: ),�( aer07–w/
Inspection Line: 503.639.4175 HH r s , ^.I I Date Ready /By: suds: ® See Page 2 for
Internet: www.ci.tigard.or.us Gt - c ' OF TIG`v'AQF► g�1 Notified/Method: Supplemental Information
`Ml xi\ IOIQ'v
t snl� PLAN REVIEW ,
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
El Demolition 0 Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2-family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
x �,) / _ r � ❑Health -care facility ['Other:
Job no.: Job site address: I (� � l Q 4 �
'( Submit 2 sets of plans with any of the above.
City/State /ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name ::�-( amn , L, FEE* SCHEDULE
J Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: IY Ift New residential single- or multi - family dwelling unit.
?�/l1 Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
• DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
N ' al 0 Services or feeders installation, alteration, and /or relocation
1 200 amps or less 80.30 2
0. PROPERTY OWNER' . I ' ❑ TENANT_ . 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1 _
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: — Each add'l branch circuit 6.65 2
City, Miscellaneous (service or feeder not included)
Phor Pump or irrigation circle 53.40 2
Melissa Hayden, Security Signs Sign or outline lighting 1 53.40 2
E m;2424 SE Holgate Blvd Signal circuit(s) or limited -
'Portland OR 97202 1 energy panel, alteration, or
extension. Describe: Page 2 2
Busip: 503 546 7114 f: 503 230 1861
AddiMelissa@SecuritySigns.com Each additional inspection over allowable in any of the above
CCB: 122809 Per inspection 62.50
City/ Investigation per hour (1 hr min) 62.50
26560CLS metro #: 2561 Industrial plant per hour 73.75
Phon
ELECTRICAL . PERMIT FEES*
CCB
�
Subtotal 5.---a ‘,./
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: �^{� Date: State surcharge (8% of permit fee) 2 • .27
��) `^' 0 TOTAL PERMIT FEE - /7 . �
Authorized signature: This permit application expires if a permit is not obtained within 18
• de/ • days after it has been accepted as complete
Print name: m GL *- iiI V [.9 Date: * Fee methodology set by Tri- County Building Industry Service Board
oft � l `�� ' ** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PerrnitApp.doc 12/03 440 -4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( rRERDENTIAL,WORK:ONLYc
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COIVIMERCIAL WORK ONLY
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260) .
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls •
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\BuildingWermits\ELC- PermitApp.doc 04/03